Is opioid-free analgesia the first tier choice in anesthesia for cesarean delivery?

We read with great interest the article “Respiratory depression after spinal single-shot caesarean section with 100 μg morphine” by Hiroki Onodera and colleagues [1] on monitoring bradypnea after cesarean section performed with 0.1 mg intrathecal morphine. The authors performed spinal anesthesia with 2–2.5 ml hyperbaric bupivacaine (0.5%) + 10 µg fentanyl + 100 µg morphine, additional seda- tion and analgesia at the discretion of the anesthesiologist, and for postoperative pain management, patients received acetaminophen 1 g IV every 6 h, while flurbiprofen and/or opioid drug and pentazocine, at the discretion of the obstetri- cian. The authors observed episodes of sustained bradypnea in approximately half of women in their study and found a low rate of cumulative bradypnea time with no related factors. Despite these results, the authors concluded that: “respiratory monitoring may not be necessary as patients undergoing cesarean delivery are generally young, healthy women”.